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Message ID: 9178
Date: 2012-06-04

Author:Chaffin, Mark J. (HSC)

Subject:RE: questions regarding parent-child visitation

Jessica, We've had some interesting experiences in research studies with the issue of parent-child interventions and how they relate to parent-child visitations. This was in the context of our two RCT's of parent-child interaction therapy (PCIT) with child welfare parents. The first lesson we learned is that many parents will welcome an opportunity for *additional* parent-child contact (i.e. will welcome assignment to a dyadic parent-child intervention like PCIT in *addition* to their regular visits with their child). In fact, the main PCIT compliance problem we encountered was on the child side--foster parents/workers who didn't want to bring the child or were too busy, and it was not uncommon to have bio parents show up for sessions and the child no-show from foster care. You can imagine how discouraging this is for parents, not to mention financially costly for the service provider. So, another implementation lesson learned and something to plan for and allocate resources carefully for if you are going to do this. As much as parents might like a parent-child interaction based intervention (rather than sitting on their tails in a parenting group), they definitely do NOT welcome "replacing" their regular visitation with therapy or an intervention. Parents seem to want their visits to be their time, not therapy time. In our trials, we had an occasional CW worker tell parents, "you're doing that parent-child interaction therapy, so that counts as your visit, and I'm cancelling your regular visitation." The parents were irate (and frankly should have been), and we had to move very quickly to correct this because it would potentially poison the therapy. Again, this was only an occasional individual worker, but it did teach us the lesson that if you are doing parent-child interventions, you need to anticipate this issue. There were other similar worker misunderstandings and problems that can arise--e.g. a parent fails a drug test, so the worker takes away the parents visitation, which could be reasonable, but then also tries to pull the parent and child out of PCIT, which is not reasonable. The point is that you may have to anticipate these kinds of misunderstandings about parent-child intervention sessions and how they differ from regular visitation and how the rules and issues are different. If you are doing parent-child dyadic interventions (like PCIT), the issues of level of supervision and risk to the child are greatly reduced because there is an interventionist involved, a structure involved, and really very little unmonitored interaction. In something like PCIT, where the interventionist is directly observing and communicating with the parent at all times, any problems can be corrected on an emergent basis, and in the worst case scenario, the session can be shut down. As I recall from our last trial that involved hundreds of parent-child sessions, staff very rarely had to send a parent home (e.g., because they were stumbling drunk, and so were rescheduled for when they were sober). Parent-child intervention session safety or sessions being traumatic or fearful for kids was really virtually never an issue. And this trial was with a "worst of the worst" CW population. Obviously, for unsupervised visits the safety issues are different, but the point again is that if you are doing parent-child interaction interventions, it's a different deal than regular visitation and has to be treated that way. While I personally think it is a good idea to replace parenting groups with dyadic parent-child interaction therapy sessions in many cases (and the outcome data strongly bears this out), keep in mind that this is both more costly and far more challenging logistically to deliver. The problem with these interventions is not their "fit" or their effectiveness, both of which are good, but their deliverability. Scheduling dyadic sessions is more difficult than scheduling groups. Failed sessions are more expensive. Burden placed on workers and foster parents to transport children is higher. WSIPP in your state has done a cost analysis on this and estimates that the return on investment is quite positive, but there is still investment involved. WA has a number of good provider agencies doing PCIT, but it still can be challenging to actually get this type of service delivered. I think the idea of piggybacking this type of intervention on top of regular visitations seems like a potential way around at least some of these challenges, but you may find that it creates new and equally daunting challenges, such as those described above. MC -----Original Message----- From: Jessica A Rodriguez-Jenkins [mailto:janrj@u.washington.edu] Sent: Wednesday, May 30, 2012 2:45 PM Subject: questions regardign parent-child visitation Good afternoon, I am currently looking at the use of parent-child visitation and potentials for use of visitation times for parent-child interventions. I have heard that in Utah there is either a pilot project or a policy in place for setting up parent-child visits within 24 hours of removal. I am trying to find out more about this and am interested in whether there has been any evaluation on this practice. I have also heard that there is a practice in California where children and parents would get a phone call within 24 hours and am wondering whether there is any information about the impact of the calls on parents and children. If anyone has any further information about either of these protocols and whether they have been associated with any outcomes it would be very helpful. I am also wondering if anyone has had experience in developing an assessment tool for determining the level of supervision required during visits? A tool to know when it is time to liberalize the visits? Thank you, Jessica ______________________________ Jessica Rodriguez-JenKins, MSW Research Assistant | Predoctoral Instructor Partners for Our Children | University of Washington School of Social Work Box 359476 | Seattle, WA 98195-9476 F: 206-221-3155

Jessica, We've had some interesting experiences in research studies with the issue of parent-child interventions and how they relate to parent-child visitations. This was in the context of our two RCT's of parent-child interaction therapy (PCIT) with child welfare parents. The first lesson we learned is that many parents will welcome an opportunity for *additional* parent-child contact (i.e. will welcome assignment to a dyadic parent-child intervention like PCIT in *addition* to their regular visits with their child). In fact, the main PCIT compliance problem we encountered was on the child side--foster parents/workers who didn't want to bring the child or were too busy, and it was not uncommon to have bio parents show up for sessions and the child no-show from foster care. You can imagine how discouraging this is for parents, not to mention financially costly for the service provider. So, another implementation lesson learned and something to plan for and allocate resources carefully for if you are going to do this. As much as parents might like a parent-child interaction based intervention (rather than sitting on their tails in a parenting group), they definitely do NOT welcome "replacing" their regular visitation with therapy or an intervention. Parents seem to want their visits to be their time, not therapy time. In our trials, we had an occasional CW worker tell parents, "you're doing that parent-child interaction therapy, so that counts as your visit, and I'm cancelling your regular visitation." The parents were irate (and frankly should have been), and we had to move very quickly to correct this because it would potentially poison the therapy. Again, this was only an occasional individual worker, but it did teach us the lesson that if you are doing parent-child interventions, you need to anticipate this issue. There were other similar worker misunderstandings and problems that can arise--e.g. a parent fails a drug test, so the worker takes away the parents visitation, which could be reasonable, but then also tries to pull the parent and child out of PCIT, which is not reasonable. The point is that you may have to anticipate these kinds of misunderstandings about parent-child intervention sessions and how they differ from regular visitation and how the rules and issues are different. If you are doing parent-child dyadic interventions (like PCIT), the issues of level of supervision and risk to the child are greatly reduced because there is an interventionist involved, a structure involved, and really very little unmonitored interaction. In something like PCIT, where the interventionist is directly observing and communicating with the parent at all times, any problems can be corrected on an emergent basis, and in the worst case scenario, the session can be shut down. As I recall from our last trial that involved hundreds of parent-child sessions, staff very rarely had to send a parent home (e.g., because they were stumbling drunk, and so were rescheduled for when they were sober). Parent-child intervention session safety or sessions being traumatic or fearful for kids was really virtually never an issue. And this trial was with a "worst of the worst" CW population. Obviously, for unsupervised visits the safety issues are different, but the point again is that if you are doing parent-child interaction interventions, it's a different deal than regular visitation and has to be treated that way. While I personally think it is a good idea to replace parenting groups with dyadic parent-child interaction therapy sessions in many cases (and the outcome data strongly bears this out), keep in mind that this is both more costly and far more challenging logistically to deliver. The problem with these interventions is not their "fit" or their effectiveness, both of which are good, but their deliverability. Scheduling dyadic sessions is more difficult than scheduling groups. Failed sessions are more expensive. Burden placed on workers and foster parents to transport children is higher. WSIPP in your state has done a cost analysis on this and estimates that the return on investment is quite positive, but there is still investment involved. WA has a number of good provider agencies doing PCIT, but it still can be challenging to actually get this type of service delivered. I think the idea of piggybacking this type of intervention on top of regular visitations seems like a potential way around at least some of these challenges, but you may find that it creates new and equally daunting challenges, such as those described above. MC -----Original Message----- From: Jessica A Rodriguez-Jenkins [mailto:janrju.washington.edu] Sent: Wednesday, May 30, 2012 2:45 PM Subject: questions regardign parent-child visitation Good afternoon, I am currently looking at the use of parent-child visitation and potentials for use of visitation times for parent-child interventions. I have heard that in Utah there is either a pilot project or a policy in place for setting up parent-child visits within 24 hours of removal. I am trying to find out more about this and am interested in whether there has been any evaluation on this practice. I have also heard that there is a practice in California where children and parents would get a phone call within 24 hours and am wondering whether there is any information about the impact of the calls on parents and children. If anyone has any further information about either of these protocols and whether they have been associated with any outcomes it would be very helpful. I am also wondering if anyone has had experience in developing an assessment tool for determining the level of supervision required during visits? A tool to know when it is time to liberalize the visits? Thank you, Jessica ______________________________ Jessica Rodriguez-JenKins, MSW Research Assistant | Predoctoral Instructor Partners for Our Children | University of Washington School of Social Work Box 359476 | Seattle, WA 98195-9476 F: 206-221-3155