Skip to main content

Project Description


Kentucky River Community Care, Inc. (KRCC), a multi-site behavioral health center located in the Appalachian Mountains of rural southeast Kentucky, was the lead agency for the RPG I grant awarded in 2007. The Families in Safe Homes Network (FISHN) focused on developing a system of care for families living in four isolated counties in the Kentucky River Region, a region with the poorest health indicators in the nation and the highest risk indicators for child well-being in the state. This region comprised less than 2% of the State's population, yet accounted for 15% of the State’s children in out-of-home care. A primary goal of the project was improved collaboration and communication across agencies serving children and families in this region. Partners sought to reverse the trend of child removals and improve child well-being, safety, and permanency by altering interventions for Department for Community Based Services (DCBS) involved families who also were involved with substance abuse. The FISHN project solidified a core group of committed agencies who promoted and adopted systems improvements. The benefits for DCBS families included expanded community supports, a referral process for behavioral health services, substitution of evidence-based practices for "traditional" counseling and parenting skills training, strengthened agency interaction, and increased availability of treatment programs for parents, children, and family members. Along with changes in collaborative practice, NIATx Process Improvement strategies were used to identify and address barriers to services in multiple systems.

In 2012, KRCC was awarded a Two-Year Extension for Families in Safe Homes Network-Initiative (FISHN-I). The grantee requested the two years of funding to expand and sustain the project by 1) serving the remaining four counties in the region, 2) developing NIATx change teams in other counties to address systems barriers and issues, and 3) integrating behavioral and physical health care in clinics throughout the region. The grantee and partners also focused on sustaining critical elements of their program.

Target Population

FISHN Targeted:

Children and families at-risk of or involved with the DCBS/child welfare due to parental substance use disorders in Breathitt, Knott, Perry, and Leslie counties. RPG extension funding enabled the grantee and partners to expand services to Lee, Letcher, Owsley, and Wolfe counties, essentially serving the entire southeast Kentucky River Region.

Major Program Goals

Goal 1: Sustain the Regional Partnership Function by diversifying the mission

Goal 2: Enrich the competency of staff by cross training multiple agency staff in trauma informed approaches for family, early childhood, and adult treatment methodologies and best practices

Goal 3: Use the NIATx approach to spread the system of care established in the four original Kentucky River counties into the remaining four counties

Goal 4: Integrate primary care into the adapted Chronic Care system of care established by FISHN partners

Major Program Services

Case Management and In-Home Services

  • Intensive/Coordinated Case Management
  • Family Group Decision Making/Family Case Conferencing
  • Wraparound/Intensive In-Home Comprehensive Services

Parenting/Family Strengthening

  • Evidence-Based Parenting or Family Strengthening Program – Nurturing Parenting

Engagement/Involvement of Fathers

  • Specialized Program or Services for Fathers

Mental Health and Trauma Services for Adults

  • Mental Health Services
  • Trauma-Informed Services
  • Trauma-Specific Services – Seeking Safety

Substance Abuse Treatment for Adults

  • Intensive Outpatient

Specialized Outreach, Engagement, and Retention

  • Cognitive Behavioral Strategies – Motivational Interviewing/Motivational Enhancement Therapy
  • Organizational and Other Strategies – Co-location of Staff, NIATx Process Improvement Teams, Immediate Access

Family-Centered Substance Abuse Treatment or Family-Based Substance Abuse Services Screening and Assessment – Child Welfare and Other Children’s Issues

  • Screening and Assessment for Child Welfare Issues
  • Screening and Assessment for Trauma
  • Other Specialized Child Screening and Assessment - Developmental, Behavioral/Socio-Emotional, Mental Health/Psychological

Screening and Assessment – Substance Use and Other Adult Issues

  • Screening and Assessment for Substance Use Disorders
  • Other Specialized Adult Screening and Assessment - Psycho-social

Children’s Services

  • Other Therapeutic Services for Children
  • Trauma Services for Children - Trauma Focused Cognitive Behavioral Therapy

Housing Services

  • Housing Support Services

Cross-Systems Collaboration

  • Clinical and Program Training
  • Cross-systems Policies and Procedures
  • Regular Joint Case Staffing Meetings
  • Co-location of Staff
  • Cross-Systems information Sharing and Data Analysis
  • Partner Meetings - Regional Partnership and Program Management


  • Coordinated Case Planning with Child Welfare Courts
  • Integrated Behavioral and Physical Health Care Coordination Teams
  • Specialized Program or Services for Grandparents and other Family

Partner Agencies and Organizations

The RPG encouraged service providers to develop and/or strengthen cross-system linkages between substance abuse treatment, child welfare, dependency court, and other service systems. The FISHN-I project included the following partners:

Child Welfare

  • DCBS/Child Welfare Agency

Substance Abuse

  • Kentucky River Community Care
  • Cabinet for Health and Family Services Community Based Services
  • University of Kentucky targeted Assessment Program
  • Operation UNITE


  • Dependency/Juvenile Courts in four counties

Criminal Justice, Law Enforcement, Legal and Related Organizations

Other Community and Child and Family Services


  • Kentucky River Community Care
  • Kentucky River Foothills Community Action Partnership
  • Housing Authority of Hazard

Mental Health

Health Services

  • Kentucky River District Health Department
  • Kentucky Mountain Health Alliance
  • Little Flower Free Clinic and Kentucky River Health Department


  • LKLP Community Action Council, INC


  • LKLP Community Action Council, INC

Other Evaluation and Training

  • University of Kentucky, Lexington


This project proposed a quasi-experimental design. The treatment group consisted of clients receiving FISHN-I services. The comparison group consisted of clients receiving typical child welfare and substance abuse services during the RPG grant period but not the RPG enhanced services.

Grantees measured performance indicators in the following domains: safety, permanency, child and adult well-being, and adult recovery. For additional information regarding program outcomes, please contact key personnel.

Sustainability Strategies and Activities

KRCC was successful in securing resources to sustain completely their RPG efforts and services beyond the Federal grant period. The creation and implementation of the RPG Learning Collaborative facilitated numerous systems changes that resulted in new ways of doing business for the RPG partners and these continued beyond grant funding. Additionally, services were sustained in part through the creation of a new billable position in Kentucky titled Community Support Associate, which supports the role of the RPG Care Coordinators.

Request Technical Assistance


Project Details

  • Lead Agency:
    Kentucky Rivery Community Care, Inc.
    Hindman, Kentucky
  • Geographic Area and Congressional District Served:
    State: Kentucky
    City of Hindman; 5th Congressional District; Rural
  • Federal Grant:
    2 years
  • Proposed Number Served (2 years):
    Children: 561
    Adults: 1,100
Back to Top