Family Interactions 1

Family Interactions
Pathway to Permanence

Jennifer S. Plitzner
Ann M. Larsen

Lutheran Social Services of Wisconsin and Upper Michigan

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Abstract

Lutheran Social Service’s Family Interaction Program is a multi-dimensional service to families

to promote attachment and permanence in a safe and supervised setting. The core philosophy is

that family interaction is a process, not a place or single event. This program is not specifically a

building or a place to go, but rather a service that occurs in the most natural setting safely

available to the individual family. Interactions could occur in a formal location, the library, the

foster home, the park or at the home of the parent(s). The Family Interaction Program is

individualized to work around the school schedules of the children, work schedules of the parents

or around Huber privileges in the case of incarceration. Services are provided seven days a week

as early as daybreak for newborns and into the evening for older children with overnight

interactions available as families progress to reunification.

In 2004, Lutheran Social Services, Eau Claire County and the Western Wisconsin Partnership,

developed the Family Interaction Program to provide a program to better meet the needs of

families with children in out-of-home placement. Over the past six years, Lutheran Social

Services has worked closely with multiple County Family Services Units to design and deliver

services that embrace the philosophies and practice standards articulated in the Adoption and Safe

Families Act (ASFA) resulting in the Family Interaction Program. LSS has participated in joint

trainings with county providers (provided by the Western Wisconsin Partnership) to implement

comprehensive, competency-based service approaches.

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Family Interactions

Pathways to Permanence

Lutheran Social Service’s Family Interaction Program is a multi-dimensional service to

families to promote attachment and permanence in a safe and supervised setting. The core

philosophy is that family interaction is a process, not a place or single event. This program is not

specifically a building or a place to go, but rather a service that occurs in the most natural setting

safely available to the individual family. Interactions could occur in a formal location, the

library, the foster home, the park or at the home of the parent(s). While family interaction is a

restrictive and imposed setting, it should be one of rehabilitation and not punishment. While

work is primarily done with the parent(s), the client is considered to be the child(ren) and the

overriding goal is permanence whether with the biological family or with a suitable placement

that can be a forever family.

Traditional supervised visitation models for families with children in out-of-home

placement, involve little more than provision of space and a monitor, sitting passively in the room

with the family taking notes, failing to address three core issues. The approach does nothing to

assist parents struggling daily with mental health issues, AODA issues, history of poor parenting

models resulting in parenting skill deficits, financial struggles and societal dysfunction.

Additionally, parents experiencing out-of-home placement with court ordered supervised

visitation as the only avenue for connection to their children, face new challenges of shame, fear,

anger and loss. Moreover, traditional models do nothing to assist families with maintaining and

building attachment. LSS and its partners set out to build a more proactive model aimed at

creating healthy, whole families.

The Field Guide to Child Welfare by Rycus & Hughes outlines the current practice

standards in child welfare. As described in the Field Guide to Child Welfare, “A developmental

model concurrently considers both deficits and potentials” (pg. vii). LSS strives to help families
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gain the skills they need to safely parent; at the same time understanding the federal mandates

that can dictate the direction and timeline of a case plan. LSS is willing and competent to make

difficult decisions if parents cannot safely and effectively parent. LSS staff provide

documentation and testimony to the courts as needed. LSS services function first to protect the

child from maltreatment and second to empower the child’s own family.

All families in the Family Interaction Program are referred by the county agency

contracting our services. Families may already have a CHIPS (Child In Need Of Protection and

Services) disposition in place or may still be in the court process. The supervising case manager

provides basic information through the referral, information related to the permanency plan and

establishes an intake meeting. At intake, necessary paperwork is completed, the program is

explained to the parent, the interaction schedule is set and establishing a working relationship

between the interaction provider, the parents and the foster parents begins.

Following intake, services begin in the formal office setting according to frequency

guidelines relevant to the age of the child. LSS is particularly sensitive to the critical importance

of infant attachment in child development and seeks to provide contact according to the following

guidelines:

Recommended amount of interaction per week:

0-2 yrs (5 to 6x) per week
School age (3 to 4x) per week
Adolescent (min 2x) per week

The Field Guide to Child Welfare states, “While in placement, the child should have

regular and frequent visits with family members and with other relatives and friends when

appropriate. Regular visitation is critical to maintaining the child’s emotional health during

substitute care placement, and is necessary to support reunification” (pg. 39). The Family

Interaction Program is individualized to work around the school schedules of the children, work

schedules of the parents or around Huber privileges in the case of incarceration. Services are
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provided seven days a week as early as daybreak for newborns and into the evening for older

children with overnight interactions available as families progress to reunification.

The Family Interaction Program provides services in three phases. In the first phase a

family begins supervised contact in a formal setting which is a safe, educational, and nurturing

environment. Four interaction rooms of varying size are available to accommodate varying

family sizes. Each room is designed to create a homey esthetic with creative wall murals,

couches, a rocking chair, a kitchen table and chairs as well as toys, games and art supplies. The

facility features a modified kitchen to allow for meal and snack preparation. During the first four

to six weeks, the family reunites after the initial separation, settles into a new routine and begins

building a relationship with the interaction worker. The worker in turn begins assessing the

family’s strength and growth areas and completes the formal CANS (Child, Adolescents, Needs,

Strengths) assessment tool. Positive family routines and traditions are intentionally identified and

incorporated into interactions.

A review meeting with the parents, county caseworker and interaction worker is held at

the conclusion of the assessment period. During this meeting, the interaction worker provides an

assessment of strengths of the family on which to build and identifies growth areas. LSS works

with the family and case manager to design a goal plan that fits the parent’s skills, mental state

and emotional impact on the child. Together, that goal plan is developed to guide the parents and

to provide for measurement of progress. The worker provides parenting assistance through

teaching, coaching, modeling and cueing in a hand’s-on manner as the family interacts. If

needed, separate review sessions and parenting education sessions are also provided. The

duration and frequency of visitation is also individualized and reevaluated on a regular basis.

Traditionally, a family moves from the most restrictive setting to increased flexibility.

Initially, the worker is present at all times with the family assuring for safety. As the parents
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demonstrate progress and the ability to safely parent, the worker shifts responsibility increasingly

to the parents and diminishes the level of supervision.

The second phase of Interactions builds on the progress of the parents and the family

begins moving into the community for visitation providing the opportunity for a greater realm of

activities and greater opportunities for the parents to practice new skills. Again, goals are

individualized such that if the primary means of transportation for the family is the bus, this

means would be utilized. Interactions also may move into the home during this phase. Care is

taken to prepare both the children and the parents and address emotional issues which may arise

from returning to the home setting. Supervision during this phase will decrease commensurate

with parental progress.

The last step before reunification is the third phase of Interactions. This phase includes

overnights with time increasing until the child moves back into the home. The worker in this

phase provides supervision by dropping in on the family, unannounced, throughout the day or

night. New goals are set, additional training is provided and progress is assessed.

Movement through the phases is fluid and self-paced with families moving both

forward and backward to accommodate progress and regression. Interaction is a process and the

families served through this program face many significant challenges. Progress is often marred

by set backs, however, movement backward in the program is not a punitive measure, but is an

opportunity for the parent to regroup, stabilize and adjust. It is not uncommon for a parent about

to move into a new phase of Interactions to self-sabotage their progress. Such an event is

anticipated, acknowledged and addressed, with goals readjusted to get the family back on track.

A variety of hurdles present during a families time in the program including but not

limited to; no transportation, unreliable transportation, no phone service, illness, non-flexible

employment, lack of housing, mental health issues and addictions. Any or all of these impact the

parent’s ability to engage and remain engaged in the process. Family interaction works closely

with the parents and county caseworker to identify and address the hurdles leading to impasse,
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while still holding parents accountable and supporting responsibility required for parenting.

When language barriers between the parent and staff exist, translators are provided. The Family

Interaction Program collaborates effectively with the HoChunk Nation as well to provide

culturally sensitive service.

Outcomes vary for the families in the program, but the outcome of permanence for the

children is an absolute. Some families may never move past the first phase or never complete the

program. LSS provides necessary documentation to the county caseworker to move toward

termination of parental rights. In those cases, LSS will continue to provide supervised contact at

the same or modified intensity in the office setting until a court decision is finalized. Others

move forward and through the process the parents come to realize that they are not able to best

provide for their children and seek voluntary termination of their parental rights assisting their

children in reaching permanence. The interaction worker, in collaboration with the caseworker,

often coaches the parent and the children through a session for the parents to communicate their

love for the children, their realization that they cannot parent the children and then give their

children permission to love their new forever family. Still other families move forward learning

new skills and developing a better understanding of what it means to parent children and achieve

reunification.

Growth, Goals and Outcomes

The Family Interaction Program began in Eau Claire County in 2005 and has tripled in

size. In addition, the program expanded in 2006, providing service in Jackson and Dunn County

in the West Central region of the state. In 2011, LSS will expand these services again beginning

in the Southeastern region of the state opening programs in Walworth and Fond du Lac counties.

The primary family-centered interaction program objectives include:

1. Strengthen the capacity of families to provide safe and nurturing care for their children.
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• Since program inception in 2005, the Family Interaction Program has served 211
client families. 100% of Interactions have been safe (no physical violence.)

• Of the families who have achieved reunification, only 13 or 6% have been re-referred
indicating that those who have been reunified have been successful after program
completion.

2. Supporting permanence and reducing re-referrals.

• Family Interaction staff adhered to DHS Concurrent Plans related to permanency in

all cases

• Since 2005, only 13 cases (6%) have returned to the program.

3. Assisting parents in identifying parenting needs and building skills.

• An initial assessment of parenting strength and growth areas was completed for every
family attending for at least 4 weeks since 2005.

• Statistics for 2010 thus far, show that 42 families completed services during the 1st, 2nd
and 3rd quarters.
o 9 of the families closed in the third phase of unsupervised contact,
demonstrated Significant Improvement (Good) on goal progress (21%)

o 11 families closed in the third phase of unsupervised contact/placement

with other parent, demonstrated Minimal Improvement (Fair) on goal
progress (26%)

o 22 of the families closed demonstrated No Positive Change (Poor) on

goal progress (53%) (Uncooperative, other parent placement,
TPR/Voluntary TPR)

o (47%) of families closed services demonstrating Significant

Improvement (Good) or Minimal Improvement (fair) on goal progress
o Family Interaction staff adhered to DHS Concurrent Plans related to
permanency in all 42 closed families (100%)

• A specific goal plan building on strengths and addressing skill deficits was created for
all families attending for at least 4 weeks with progress through the phases as follows
for 2010.
o Cases that closed in Phase 1 closed with 65% due to “Uncooperative”
and 35% due to “Placement with Other Parent”

o Cases that closed in Phase 2 closed with 50% due to “Reunification” and
50% due to “Reunification with Other Parent”

o Cases that closed in Phase 3 closed with 100% “Unsupervised Contact”.

4. Decreasing time of services needed for resolution.

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• Since 2005, Family Interaction cases have ended with approximately 87% closing
within the federally mandated time frame for permanence of 15 months. 6% of cases
remained open past that time period due to court ordered extensions to allow for
mitigating circumstances and 6 % were re-referred

o 0 – 4 months - 73 cases (35%) closed within this time period

o 5 – 9 months – 79 cases (37%) closed within this time period

o 10 – 15 months – 33 cases (15%) closed within this time period

o 16 – 24 months – 6 cases (3%) closed with this time period

o 24 + months – 7 cases (3%) closed within this time period

o Re-referred – 13 cases (6%) returned to the program

Department of Human Services Satisfaction Survey

The DHS Satisfaction Survey gives the Department of Human Services and other funding

sources the opportunity to provide feedback regarding the services they received. The Family

Interaction Program continues to strive to maintain optimal communication with referring

workers on a weekly basis. 42 families were closed during the 1st, 2nd and 3rd Quarters of 2010.

Of the 42 satisfaction surveys sent to referring workers, 25 were returned. Of those 25

respondents, all were satisfied with the services provided by the Family Interaction Program.

(Return Rate = 60% - overall satisfaction rate = 100%).

Case Study Summary: Mary

Mary, 19yrs old, was referred to the program following substantiated child abuse, later

resulting in criminal conviction. At opening, Mary had two children by two different fathers.

Child 1, the victim, was 2 ½ years old and was placed with biological father and grandmother.

Child 2 was 15 months old and placed with maternal aunt. Mary was reported to be of low IQ.

Mary presented demonstrating guilt but minimizing the abuse. She reported significant concern

about what people would think of her. Mary had few parenting skills and demonstrated the need

for her children to like her. Mary had no stable home and became homeless, later going to live

with an elderly family member. Interactions eventually took place in that home. Mary reported
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significant abuse at the hands of her father as a child and teen and continued abuse by boyfriends.

Mary had little confidence and verbalized little hope for change, but was receptive of assistance.

Mary faced a six month jail term related to the abuse conviction and eventually served 1 month in

jail and then 5 months restricted to her relative’s home with electronic monitoring.

Mary remained in the program for 24 months. She received multiple services through

various agencies including therapy through LSS. The Interaction worker built a relationship of

trust with her, empowering her related to her potential, and began teaching basic parenting

through direct instruction and modeling. During her time in Interactions, Mary moved forward

and backward through the phases of the program several times. The progress and regression

mirrored life choices with negative results including an ongoing dysfunctional relationship with

Child 2’s father, a new relationship with an abusive man, a subsequent child, lack of housing, and

lack of employment. However, despite steps back, Mary remained open to the process of

Interactions, maintained and built attachment with her three children and continually made

progress both in her parenting and her life choices. When Mary completed the program, she had

obtained subsidized housing, had secured a full time job, had placement of two of the three

children, with Child 1 having unsupervised visitation. Since closing, Mary has regained custody

of Child 1, has been promoted, moved to a bigger apartment, and has managed her adult

relationships in a manner that provides safety for her children. Mary is an example of the tailored

nature of the Family Interaction Program, allowing for progress and regression, self-pacing and

creative approaches to meeting her needs related to the ability to safely parent.

Summary

The Family Interaction Program provides services beyond what county caseworkers

could ever provide due to time constraints, freeing them from supervised visitations and allowing

them to dedicate time to case management. Family Interactions provides for visitation in a safe

and nurturing environment supporting and building attachment for children in out-of-home care.

Family Interactions provides hand-on parenting training and provides the opportunity for parents
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to incorporate new skills in a safe setting. Family Interaction provides ongoing, long term

observation of families allowing for time tested progress and provides detailed documentation to

the courts supporting permanency decisions.