Lifelong Families Model Shows Early Success

Posted March 27, 2012, By the Annie E. Casey Foundation

The Brochero family’s well-kept, green ranch house sits on a gentle knoll in a quiet suburb of Hartford, Connecticut. Their yard provides ample space for their children and three exuberant dogs to romp and play.

Inside, the house is warm and welcoming, and painstaking improvements show the love and pride that Gina and Luis Brochero have invested in creating a home for their children. Both born in Colombia, they immigrated to this country in the mid-1980s and became citizens 10 years later. The family has grown by two, with the arrival in 2011 of foster sisters Caitlin, now 11, and Carol, 13 (not the girls’ real names), whom the couple is preparing to adopt. Son Timothy, 23, is away in the Air Force. Adam, 15, is a high school sophomore.

Both autistic, Caitlin and Carol were separated for years after being taken into state custody and now must get to know one another again. Their birth mother, who struggled with serious mental health issues, was unable to care for them and keep them safe. Caitlin was last in a group home after several unsuccessful foster home placements; Carol also has moved several times while in foster care.

Caitlin’s disability is mild. She is sometimes withdrawn and has trouble with forming words, completing her fifth grade schoolwork, and building relationships. Carol’s struggles are greater. Her speech is often disjointed and slurred, her balance uncertain, and her resistance to authority pronounced. Carol, a seventh grader, cannot read or write and receives special education services.

Today, Caitlin, beaming, proudly holds up an art class certificate earned “in recognition of excellence.” Carol leaps into the center of the living room floor. One hand on the brim of her black Fedora, the other swinging in time with her dancing feet, “I’m going to be a rock star when I grow up!” she announces. Caitlin dashes off to get her guitar and begin an energetic accompaniment. The girls, virtual strangers when they arrived, now have fun together. But Carol has had the hardest time adjusting to her new life. She can be aggressive and volatile.

“At first, I couldn’t control her,” Gina Brochero, a registered nurse, recalls. “Her frustration would build, and she would act out, crying and screaming.” Last night, near wit’s end, Gina called her Casey Family Services social worker, Colinda Hunter, for advice.

In dealing with these mini-crises, Adam, Gina, and Luis have called upon skills and tools they have learned in training and team meetings provided as part of Casey’s Lifelong Families model, which works to ensure that all children exit foster care to permanent, loving families and get the support needed to sustain them.

“Permanency teams,” which engage family members, professionals, and other important people in a child’s life, are the backbone of the model, providing continuous support and guidance and making the child the central and primary focus. The Brocheros’ team includes Hunter as well as a Casey family support worker, the children’s state social worker, Carol’s former foster mother, a psychologist, and other clinicians. Together, they have helped the Brocheros understand the girls’ diagnoses and needs.

The Lifelong Families model focuses on five core components to help children in the child welfare system move toward lifelong families as quickly as possible: teaming, preparation, case management, family identification and engagement, and support planning. Casey Family Services, the Annie E. Casey Foundation’s child welfare agency, is conducting a comparative outcome study and collecting data in order to develop this model into an evidence-based practice, meaning one with scientifically demonstrated results through rigorous evaluation. As it works to finalize the Lifelong Families model for replication, Casey is developing “fidelity” measures to ensure that practitioners adhere to the model’s core components.

“We have taken proven best practices in the field and blended them together in one unified whole,” explains Lauren Frey, permanency director for Casey Family Services. “Many children in foster care have compartmentalized the relationships in their lives and have had to end some in order to begin others,” notes Frey. “Bringing all those relationships into the picture and talking about them is important, and bringing other ‘sympathetic’ adults into those relationships—coaches, teachers, friends—helps these kids build extended family relationships.”

To find and engage a potentially permanent family, Frey says, “We look to everyone who knows and cares about these kids for help in locating a birth family member who may well be able to parent now, even though they could not in the past.” Adding to the complexity of the work, most children referred to Casey Family Services are older and have severe challenges and needs. In 2011, 61% were age 9 or older.

In 2009, the most recent year for which the following data are available:

  • 50% had a failed family reunification prior to coming to Casey; 
  • 50% had multiple psychiatric diagnoses; 
  • 38% had a special education classification; and 
  • 55% had been in group care or a psychiatric hospital.

Currently, Casey provides high-level care, known as treatment foster care, to youth in Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont, as well as to young parents and their children in Baltimore, Maryland. Since Casey implemented the Lifelong Families model in 2005, the number of children and youth who achieve permanence within 18 months has steadily increased. In 2005, 36% of youth exiting foster care achieved permanence, 15% of whom did so within 18 months. In 2011, the share of youth exiting foster care to permanent homes jumped to 58%, with 67% doing so within 18 months.

Preliminary data from 2008 through the third quarter of 2011 also show that:

  • In cases where youth were age 12 or over, 87% participated in their permanency teams; 
  • 73% of teams involved birth family member(s); 
  • 100% of teams involved foster family member(s); 
  • 84% of youth said that their opinions were included in their plans; and 
  • 77% of team participants interviewed said that the plans addressed all of their concerns.

One of the most significant gains, in the view of Diane Kindler, Casey Family Services clinical director, “is that we are much clearer about working on trauma, and that strengthens the model.” Whether the permanency goal is reunification, adoption, or guardianship, she notes, everyone involved needs to understand the long-term impact of trauma, which most foster children have experienced.

Of the children and youth in the care of Casey Family Services, a third reunify with birth families; a third are adopted or in the guardianship of kin; and a third leave to live independently. Casey is working to ensure that all leave with permanent family connections.

Ultimately, success depends on recognizing that foster care placement, no matter how stable and safe, “is only a tool, a pathway to lead the child back to a family,” notes Frey, who is pleased with the promising preliminary results of the Lifelong Families model and the interest several states have shown. For Caitlin and Carol, permanence may come just in time. Despite her difficulties with reading and writing, Carol expresses it powerfully in her rap music lyrics:

“The music of my heart is coming, 
“And you will see me happy. 
“Stay together. Don’t argue. Don’t say, ‘Is this happening?’
“Forget about the sad stuff. 
“Somebody teases you…Forget about it. Don’t cry. 
“Sometimes families fly away and you miss them.
“Sometimes they forget you and you miss them.
“Your love is coming.”

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