The Health Federation of Philadelphia (HFP) developed and is leading a collaborative effort that increases child, parent and family well-being for children birth to six who are involved in child welfare and affected by parental substance use disorders. Partners include the City of Philadelphia Departments of Human Services, Behavioral Health and Intellectual disAbility Services and the Family Division of the Philadelphia Court. Secure parent-child attachment is fundamental for child, parent and family well-being and understanding the negative impact that child maltreatment coupled with parental substance use disorders has on forming secure child-parent attachments. This project will test the efficacy of integrating Child-Parent Psychotherapy (CPP), an evidence- and relationship-based treatment model, with: 1) a unique "one-stop-shopping" program, the Achieving Reunification Center (ARC), for families with children in out-of-home placement; and 2) families receiving in-home protective services. Additionally, the project works to improve the overall system of services for young children affected by parental substance use disorders by strengthening existing partnerships and interagency collaborations and expanding cross-system training.
General: Families with children who are between the ages of birth to six and involved in the child welfare system as a result of or largely due to parental substance use disorders. We will work with families with children in out-of-home placement and those receiving in-home protective services.
Inclusion/Exclusion Criteria: Families must reside in the City/County of Philadelphia and be involved in the City’s Department of Human Services.
In-home/Out-of-home Focus: Both
Major Project Goals
Goal 1: Promote child well-being by addressing and helping children involved in the child welfare system overcome the developmental, social, emotional and behavioral effects of abuse, childhood and traumatic experiences, in particular parental substance abuse;
Goal 2: Increase parents'/caregivers' with substance use problems protective, bonding and attachment capacities with their children and, in so doing, enable them to engage in safe, stable and nurturing relationships with their children; and
Goal 3: Increase and fully institutionalize ongoing, seamless communication and information sharing and a shared collaborative, trauma-informed, family-centered philosophy and approach among all of the systems and myriad staff working with families involved in the child welfare system as a result of or in large part due to their parent or caregiver's substance use.
Key Major Program Services
- Child-Parent Psychotherapy
Case Management/Case Conferencing
- Intensive Case Management
- Child-Parent Psychotherapy
- Child-Parent Psychotherapy
- Child-Parent Psychotherapy
Partner Agencies and Organizations
The Regional Partnership Grants encourage service providers to develop and/or strengthen cross-system linkages between substance abuse treatment, child welfare, dependency court and other service systems. The following partners are included:
Community Health Service Provider
- Health Federation of Philadelphia, Inc. - lead Agency
- Philadelphia Department of Human Services
- Community Umbrella Organiztions (CUAs)
- The Achieving Reunification Center (ARC)
Substance Abuse/Behavioral Health Organization
- Department of Behavioral Health and Intellectual DisAbilities Services
- Family Division of the Philadelphia Court
Project and evaluation staff regularly disseminates program findings through a series of research summaries developed by Wilder Research. To date these have included summaries on Demographics, Parenting and Parent Well-Being. Additionally program leaders and staff regularly make presentations at local partnership and other department and inter-departmental meetings and have successfully submitted abstracts and made presentations at several national grantee meetings and/or other conferences. Program staff submit information for publication in peer-reviewed journals and continue to post pertinent information to relevant websites and blogs and use social media to convey important messages.
Sustainability Strategies and Activities
Involvement of Partners: The Regional Partnership Key Stakeholders group meets bi-annually; the Steering Committee meets monthly. Project leaders and staff attend and are involved in numerous other collaborative groups focused on cross-system improvement among the key partners including:
- Philadelphia Children’s Roundtable – Family Division of the Philadelphia Court and Department of Human Services
- Evidence-Based Practice and Innovation Center – Department of Behavioral Health and Intellectual disAbilities Services
Institutionalizing Strategies: DBH, the major funder of clinical behavioral services in the county, expanded its support through dissemination, training and payment for CPP clinical services within its current and/or expanded network of providers. In addition, opportunities for program funding are explored with our partners.
One of the goals of the RPG program is to gather information on approaches that improve the well-being and functioning of families affected by substance abuse, in which children are at-risk of maltreatment. To achieve this goal, each RPG grantee is conducting an independent evaluation of its program. The Health Federation of Philadelphia (HFP) is conducting an evaluation of 225 parent-child dyads, who are participating in Child-Parent Psychotherapy. CPP is an evidence-based trauma treatment for children from birth through age 5 and their caregivers; it focuses on supporting and strengthening the parent-child relationship in order to restore children’s sense of safety and develop their socioemotional functioning. Program participants receive CPP and the standard services offered by the referring agency, which may include case management, outpatient mental health services for individuals and families, drug and alcohol relapse prevention groups and treatment referrals, parenting and family strengthening programs, employment services, GED classes, vocational training, housing assistance, financial counseling, psycho-educational groups and on-site childcare. For the first few years of the initiative, some families were randomized into a control group, which received services from the referring agency but did not receive CPP. In addition to the evaluation of CPP, HFP is conducting some activities to analyze implementation and overall system change.
Outcome Study Design: DHS refers parents in the process of reunification with their children to the ARC and then ARC staff assesses to determine whether CPP may be an appropriate service. If so, an ARC staff member refers the caregiver to HFP.
Parents and children receiving in-home protective services are also eligible for the project including referrals from Mother/Baby substance abuse treatment programs.
HFP is collecting outcomes in the areas of child well-being, permanency and safety; family functioning and stability; and adult recovery. It collects data on these outcomes 12 months after baseline assessment. The sources of data for the evaluation include direct assessments collected for the evaluation, clinical data collected by clinicians, and administrative data. HFP obtains administrative records on child welfare and mental health and substance abuse treatment through data sharing agreements with DHS and the Philadelphia Department of Behavioral Health and Intellectual disAbility Services.
Additional Evaluation Components: HFP is also conducting some evaluation activities related to the overall system. The system-level evaluation evolves on an ongoing basis to reflect the emerging needs and interests of program staff and system partners. Some evaluation activities have included collecting system-level perspectives from a variety of stakeholders, assessing the strength of the collaborative partnership, collecting clinician perspectives regarding their implementation of CPP and documenting systemic barriers that may challenge families participating in CPP.
RPG National Cross-Site Evaluation Participation: In addition to conducting its own local evaluation, HFP is participating in the RPG cross-site evaluation studies of family outcomes, program implementation and RPG partnerships. HFP is one of several grantees participating in an impact study conducted as part of the cross-site evaluation to examine program effectiveness.
The Health Federation of Philadelphia (HFP) is a nonprofit public health organization dedicated to improving access to and the quality of health services for underserved and vulnerable individuals and families. HFP serves as the lead agency for the project. Maria Frontera and Leslie Lieberman, senior managers at HFP share responsibility for oversight of all planning, development, management, evaluation and ongoing community relations of the project. Una Majmudar serves as the fulltime Project Manager and is responsible for oversight of all day-to-day activities for the project as well as direct supervision of the three clinical CPP Specialists and the Evaluation Specialist.
Representatives from the key partner organizations and systems participate in the Steering Committee and the Partnership Stakeholders Group. The Steering Committee met weekly during years one and two of the Project and now meets monthly. The Partnership Stakeholders began as a monthly group and now meets bi-annually. Together, these groups review progress on the project goals and objectives, and advise and recommend changes as needed.