Too often great ideas are kept in-house without recognizing their potential to create change beyond the communities where they are born. COA’s Innovative Practices Award (IPA) identifies, documents, and celebrates examples of successful approaches to management and service delivery practices adopted by our accredited organizations.

In 2020, a committee made up of COA volunteers and staff selected 4 finalists to move forward with a full case study. Alternative Family Services (AFS) came out the winner. Read on to find out how the AFS Enhanced Visitation Model kept families in touch during the crisis of COVID-19.

Helping families stabilize, heal, and reunify is an essential part of the work at Alternative Family Services. In-person visitation between kids in foster care and their biological family members is an integral part of the therapeutic process. The frequency of visits between parents and their kids are one of the strongest predictors of the family reuniting. The COVID-19 pandemic exacerbated the challenges kids and families must overcome on their journey towards reunification.

As the magnitude of the COVID-19 pandemic became more apparent, AFS staff and clients were suddenly faced with the reality that in-person visitation between kids and their family may be halted, or at the very least severely restricted. The ever-changing state and county guidelines added uncertainty and stress to the situation. Since many of our AFS staff, biological families, and foster families are considered a “higher-risk” demographic to have serious consequences from COVID-19, there was palpable fear in conducting in-person visits. AFS staff knew it was critical for families to continue to stay connected, especially during such uncertain times. So, a taskforce was formed that included representation from key AFS stakeholders. The group was asked to create a safe and equitable plan that would allow in-person visitation to resume. After much input and deliberation, the Enhanced Visitation Model was approved.

Exploring the AFS Enhanced Visitation Model

Health Risk Assessment

It was important for AFS staff to evaluate and address client’s COVID-19 concerns and mitigate the risk of individual exposure to the virus. The taskforce sought input from its constituents, researched professional resources, and ultimately developed the “Wellness Questionnaire.” Staff can rapidly administer this assessment tool to determine COVID-19 risk factors each visitor had been exposed to within the 14 days prior to an in-person visit.

Visitation Service Plan

A “Visitation Service Plan” is a simple, flexible, and predominately check-box/circle-based tool that seamlessly incorporates the risk factors identified in the “Wellness Questionnaire,” assigning families to one of three visitation service levels according to COVID risk level:

• Community-based (Low Risk): local government, community mandated precautions only (masks, handwashing, appropriate hygiene precautions)
• Social Distance Enhanced (Moderate Risk): physical distanced “Enhanced Visitation Venues” required
• Virtual Visitation (High Risk): virtual visitation only

AFS staff wanted to provide therapeutic strategies in a fun, genuine, and safe environment regardless of their Visitation Service Plan. Once the assessment and planning tools were established, staff needed to create pandemic-safe stations for families to interact.

Enhanced Visitation Venues

When families have a positive, stress-free visit, they are more likely to retain and practice the therapeutic skills they learn.  So, AFS staff developed a variety of indoor and outdoor “Visitation Venues” that are fun, affordable, replicable, and portable. The visitation venues meet COVID-19 safety protocols so parents and their children can safely interact. Here are some examples of our indoor and outdoor venues:

Indoor Visitation Venues

• The Hugging Station provides families with the opportunity to physically embrace, parents and children put on arm-length disposable gloves before reaching through sleeves attached to a transparent plastic curtain so they can safely hug during the pandemic. The Hugging Station can be easily decontaminated after each use. 
• Activity Tables feature a Plexiglas divider, which sits on a table with parents on one side and child(ren) on the other. Participants can paint outlines of each other, play Tic-Tac-Toe or jointly create drawings with dry-erase markers, among other options.
• The Interactive Puppet Theater is where kids and parents make easy-to-construct sock puppets to safely “perform” in the puppet theater. It was designed with a table, clamps and Plexiglas with precut holes modified with rubber shields. AFS organized one-hour sock puppet workshops for staff so they can teach clients how to construct their own puppets for this playful encounter.
• Gaming Stations featuring video game consoles and large television screens allow families to play video games together while sitting at least six feet apart from one another, to ensure proper social distancing.

Curious to see what these options look like? Check out  this video that highlights our indoor visitation venues.

Outdoor Visitation Venues

Since research has shown COVID-19 is less likely to spread between individuals while outdoors, AFS staff has developed a variety of safe outdoor venues that can easily be setup and disinfected after each use. When visits occur in the parking lots of one of our offices, artificial turf and gymnastic mats provide ground cover for families to play outdoor games. Pop-up tents provide shade when necessary, and bikes and tricycles are provided for families to ride together (staff uses a Clorox Total 360^® Disinfectant Cleaner between uses).

AFS Visitation in 2021

The AFS Enhanced Visitation Model, funded with the assistance of the Walter S. Johnson Foundation, was the winner of COA’s 2020 Innovative Practices Award. While we were humbled to be selected, we are always striving to be innovative when it comes to providing the highest level of care to our children and families. At the end of every Enhanced Visitation Session, staff collects feedback from families to see what they like and what they feel has room for improvement.

While we are thankful that the COVID-19 vaccine is being distributed, AFS will continue to adhere to our Enhanced Visitation Model for the foreseeable future to ensure that staff, families and resource parents remain safe.

The views, information and opinions expressed herein are those of the author; they do not necessarily reflect those of the Council on Accreditation (COA). COA invites guest authors to contribute to the COA blog due to COA’s confidence in their knowledge on the subject matter and their expertise in their chosen field.

Alternative Family Services

Founded in 1978, Alternative Family Services (AFS) provides thoughtful, informed care, adoption and mental health services to foster children and youth throughout Northern California. The mission of Alternative Family Services is to support vulnerable children and families in need of stability, safety and wellbeing in their communities.

AFS, a COA-certified foster family agency, currently serves the diverse and varied needs of 1,500 foster youth, plus their biological and foster families, in the San Francisco Bay Area and Greater Sacramento Regions. Services provided by AFS include therapeutic foster care, Intensive Services Foster Care, support for foster children with developmental disabilities, therapeutic visitation, community-based mental health services, transitional housing support, independent life skills training, and much more.

COA would like to congratulate Alternative Family Services (AFS), a Resource Family Agency and mental health service provider serving Northern California, as winner of the 2020 Innovative Practices Award for its “Enhanced Visitation Model: Foster Care” program!

The Innovative Practices Award identifies, documents, and celebrates examples of successful approaches to management and service delivery practices adopted by our accredited organizations. Too often great ideas are kept in-house, without recognizing their potential to create change beyond. The purpose of the Innovative Practices Award is to amplify the effect of one great idea by elevating it to the national stage and offering it as a resource for direct service providers, leadership, researchers, and advocates across the full spectrum of human services. 

This year, innovation is more important than ever. The COVID-19 pandemic has challenged every sector of our society, but it has presented special obstacles for the human and social services field. 2020 has also reinforced the urgent need for better equity, diversity, and inclusion. With that in mind, COA requested that Innovative Practices Award submissions address one or both topics.

This year’s evaluation process began with a preliminary round of submissions in which applicants provided a one-page synopsis of their innovative practice. Four finalists were selected to move forward and submitted their full case studies, which were reviewed by a team of expert judges. The community got to weigh in, as well, with hundreds of public votes making up 5% of each submission’s final score.

You can view the case study of the Enhanced Visitation Model program here.

ABOUT THE ENHANCED VISITATION MODEL PROGRAM

Visitation frequency between parent and child is one of the strongest predictors of successful family reunification within the foster care system. The initial response to the COVID pandemic for many agencies and institutions charged with overseeing family visitation was to restrict face to face services. Even as government and private agencies have begun to reinstitute face-to-face visitation, it is clear that the pandemic will ebb and flow. If visitation is going to be available to all families, some families will need to practice social distancing or utilize virtual technologies during visitation in order to contain contagion and meet foster parent fears and demands for safety. Families involved in the foster care system are often distrustful of how resources are allocated and rules are applied. When restrictions are placed upon parents’ right to visit their child, it is imperative that the process be transparent and equitable. To accomplish its purpose, the visitation experience must also be positive and encourage healthy interaction.

AFS’ Enhanced Visitation Model incorporates risk assessment and visit planning tools to assist staff in developing transparent and equitable visitation plans for all families. They have coupled this with replicable visitation activities or venues that can safely provide a continuum of healthy visit experiences regardless of risk level. Three levels of visitation service delivery address the special needs of families required to adhere to community, social distancing, or quarantine requirements. AFS’ Enhanced Visitation Model is designed to inspire clients and parents to play and communicate freely while minimizing the potential for client and family re-traumatization that can be caused by difficult to enforce rules and restrictive visitation environments. Their Enhanced Visitation Model is intentionally easy to replicate. They hope their model inspires and encourages family visitation providers to address the challenges of the COVID19 environment with innovative and creative visitation practices for all the families they serve.

Learn more about Alternative Family Services at afs4kids.org.

Too often great ideas are kept in-house without recognizing their potential to create change beyond the communities where they are born. COA’s Innovative Practices Award (IPA) identifies, documents, and celebrates examples of successful approaches to management and service delivery practices adopted by our accredited organizations.

In 2018, a committee made up of COA volunteers and staff selected 6 finalists from over 45 Innovative Practices Award submissions to move forward with a full case study. The St. Louis-based Foster & Adoptive Care Coalition’s 30 Days to Family^® came out the winner. Read on to find out how 30 Days to Family^® is leading the charge to create stability for kids in the chaotic world of foster care.

Seven siblings entered foster care when they were discovered in deplorable conditions with no food or water. With no known relatives in the area, they were split up between four separate, distant foster homes. Eight days after our team stepped in, all children were placed together, and, one year later, are still in the same home.

Maliek’s father’s beating sent him to the hospital. Lost to addiction, his mother was nowhere to be found. His grandmother, a refugee from the Rwandan genocide, wanted custody, but because she spoke limited English, the licensing team refused to accommodate her. His aunt also wanted custody but lived out of state. The Coalition stepped in to provide translation services and one-on-one training with grandma so she could become a licensed relative provider for Maliek while his aunt went through the lengthy ICPC process. One year later, Maliek was happily in the guardianship of his aunt, his grandmother living in to assist with childcare.

* * *

By the start of the opioid epidemic in 2011, the St. Louis-based Foster & Adoptive Care Coalition had become family-finding experts. We were the first agency in the country to utilize full-time private investigators, and our work was featured in The New York Times and TIME Magazine. But like everyone else, we were doing family finding for children who had already spent years in foster care.

Why were we waiting? We know that long-term foster care is bad for kids. We know that extended family experience deep grief because they’ve lost a child to the system for years. And we know that relatives often respond to requests for help by telling us, “I said I could help years ago, but then nothing happened.”

The Fostering Connections Act of 2008 mandated that all family members be alerted within 30 days of a child entering foster care, but we know that doesn’t happen. Lack of time, tools, and training mean a caseworker identifies an average of only seven relatives. Though a safe, appropriate family member could have been found, a nonrelative foster parent is called and, as a result, children suffer in isolation from their culture of origin, school, neighborhood, and church.

To make matters worse, Missouri does not have enough foster homes to deal with a steep increase in the number of children entering care due to the opioid epidemic. In the last 10 years, Missouri has seen a 42% increase in new entries, with more than 20,300 children spending time in foster care in 2018.

Realizing an opportunity to do better work up front, we created 30 Days to Family^®.

30 Days to Family^® is an intensive, short-term intervention that places children in the homes of safe and nurturing relatives within 30 days of entering foster care. It works because 30 Days to Family^® Specialists are required to find an average of 150 relatives for each child or sibling group. In the last eight years, we’ve learned many lessons about how to find and engage family. Here are the top three:

Work fast

Every night in foster care for a child is a night in crisis. That’s why we initiate 30 Days to Family^® the moment a child enters foster care. A member of our team attends the child’s first protective custody hearing to create a sense of urgency around the case. The more time a child spends in care, the more likely it is that relatives will fall away or disengage. Immediacy is key.

And that attitude of immediacy permeates every aspect of every case. If a relative expresses interest in providing placement, we drop everything and assess for safety on the spot. Relative foster parents shake up their entire lives when they agree to care for our kids; the least we can do is match their enthusiasm and flexibility.

“We operate from a mindset of ‘don’t put off tomorrow what can be completed today.’”

When it comes to 30 Days to Family^® cases, regular business hours do not apply. We operate from a mindset of “don’t put off tomorrow what can be completed today.” The early tasks in a case are critical for setting the tempo and tone of everything that comes after. Our team never wants to let an opportunity slip through their fingers to find a safe, appropriate relative for a child and get the whole professional team on the same page.

But we don’t slow down once a relative steps forward. Our Specialists bring the same sense of urgency to support as to recruitment. We will not allow a disruption because daycare isn’t in place and the caregiver has to choose between a job and a child. This person became a parent days ago – they have a million things to deal with and calling daycares for openings or doctors for Medicaid eligibility distracts them from meeting the needs of the child in their care.

Engage everyone

When it comes to our kids, everyone has something to contribute. While they may not be able to take placement, a retired uncle may be able to transport the kids to appointments, grandma could watch them after school, or a cousin could help cook dinner on her nights off.

You simply never know when you will find a relative with something amazing to give. To that end, we will contact every living adult relative despite their background, criminal history, abuse and neglect history, social situation, or living conditions. Even if they aren’t appropriate for placement, they may know of a long-lost relative who will prove invaluable in supporting the family. Everyone has a piece of the puzzle.

Often, our team will hear that an aunt or grandparent doesn’t want to be involved – they had enough of mom and dad years ago. Or maybe they don’t trust the child welfare system. A key to our success has been to never take that at face value. We always reach out to hear their story, and often find that if we listen actively and with empathy, they will become an active part of the child’s life.

Another thing that sets 30 Days to Family^® apart is its commitment to involving paternal relatives. We do not wait for paternity to be established to reach out, as we’ve found that cousins or grandparents will often step up if they know the children. Biological relation is not a deciding factor for many of our caregivers. Many will ask for placement even after a conclusive paternity test shows they have no relation to the child.

However, we do always attempt to establish paternity. We know kids do better when they’re connected to family. To that end, we’ll do our best to give them as much information as possible. We’ve even begun conducting our own paternity tests to speed things up.

Support always

“Focusing on natural supports strengthens the caregiver’s existing social network, offers more flexibility, and gives kids more relative connection.”

Just as important as finding a relative placement is putting an end to what we call “relative dumping”– you know, when grandma is asked to take in her four grandkids with no support. Say grandma has a good job at a factory, but inflexible shifts. Suddenly, all the kids in her care need physicals, dentist appointments, psychological exams, new school enrollment, court dates, and team meetings – all within a month. Instead, our team utilizes our proprietary Roadmap to Family, which guarantees all formal and informal supports are in place to keep grandma focused on caring for her grandkids.

The Roadmap to Family is a thorough, culturally competent plan created in concert with the family. Everyone has buy-in and makes a commitment. Our team focuses on “natural” supports rather than “prescribed” supports: We’ll find a cousin to take the kids to their doctor’s appointments rather than rely on public transportation, or an aunt who is a math teacher instead of hiring a tutor to help with homework. Focusing on natural supports strengthens the caregiver’s existing social network, offers more flexibility, and gives kids more relative connection.

Another key to 30 Days to Family^® is the inclusion of backup placements, often more than one. Should a placement disrupt, having multiple relatives lined up to step in ensures that the kids stay with family and are not forced to go to a stranger’s home. It eases the burden on overworked caseworkers, who otherwise might place the child in residential care due to a shortage of available nonrelative foster homes. Our team fully vets each backup as though they were taking immediate placement, so there is as little friction as possible in the event a disruption happens.

Finally, we conduct intentional, direct follow-up with caregivers at two weeks and 30 days after the end of services. We want to know if and how they’re utilizing the Roadmap to Family, if there’s any support they lack, any barriers they’re facing, or if they feel there’s any risk of the child disrupting. We want to make sure they feel supported and set up for success. If the caregiver needs anything, our team jumps back in – whatever needs to happen to minimize the disruption in the child’s life.

What’s in it for our kids?

In 2015, we secured funding for a multi-year, independent study of the 30 Days to Family^®. Dr. Anne Atkinson with PolicyWorks, Ltd., a think tank based in Virginia, matched children served by 30 Days to Family^® with comparable children who received services that were business as usual. The results were stunning. Children served by 30 Days to Family^® exited foster care 91.4 days earlier on average. If the child had an identified disability, s/he exited foster care 257.8 days earlier. Not surprisingly, most children achieved permanency through reunification, adoption by their relative, or guardianship, reducing the need for nonrelative adoptive homes.  Also, children served were half as likely to spend time in an institution (26% vs. 14%). Excitingly, children served were 81% less likely to experience placement disruptions.

By increasing permanency and stability and reducing the toxic overuse of residential treatment, 30 Days to Family^® has created resilient placements which created a wide range of benefits for children, such as:

• More positive relationships with mom (61% served vs. 30% not served)
• More connection to paternal relatives (79% vs. 29%)
• Greater involvement in extra-curricular activity (60% vs. 45%)
• Higher employment for working-age teens (60% vs. 21%)

Additionally, Dr. Atkinson’s study was the first economic child welfare study of its kind in the United States. It demonstrated that every child served by 30 Days to Family^® saves taxpayers an average of $10,217.61. Average savings increased to $21,687.26 for children nine and older.  These numbers do not include intangible benefits such as reducing foster parent recruitment costs and easing caseworker workload.  Neither does it include second-and-third-tier benefits, such as reduced Medicare costs and savings from lower percentages of children spending time in institutions. Our 30 Days to Family^® Specialists can serve a minimum of 30 children per year, resulting in at least $300,000 in savings.

* * *

Family search and engagement takes work, but the rewards are worth the up-front investment of your time and resources. 30 Days to Family^® represents the way forward for an overburdened child welfare system. By deepening family involvement and relationships, we build resilience among our most vulnerable children and increase buy-in in our community. By creating stability in their chaotic lives, we give our kids a chance at a genuine childhood, in which they can develop meaningful, long-term relationships, succeed in school, and pursue their passions. By being good stewards of public resources, we model responsibility and accountability. By rigorously evaluating and means-testing our own work, we set a precedent that children in foster care deserve the best we have to offer.

If your organization is interested in the 30 Days to Family^® model, please contact the Foster & Adoptive Care Coalition’s Director of Program Replication, Melanie Moredock, at melaniemoredock @ foster-adopt.org.

The views, information and opinions expressed herein are those of the author; they do not necessarily reflect those of the Council on Accreditation (COA). COA invites guest authors to contribute to the COA blog due to COA’s confidence in their knowledge on the subject matter and their expertise in their chosen field.