Massachusetts Patch: a community connected pratice to enhance child welfare outcomes
By Carolyn Mower Burns and Pamela Whitney
Carolyn Mower Burns
Introduction
In child welfare circles we are continuously learning how to improve our ability to keep children safe and how to preserve the best, lasting family and community relationships to foster their development into adulthood. To accomplish this, we are on a perpetual search for the comprehensive picture of the lives of children and their family caretakers. We seek updated methods and expertise to widen the lens from the narrow “pinhole” check-in that focuses on an incident at a given point in time, toward a broader and more penetrating inquiry. Unless a child has an obvious injury, the traditional investigation sometimes reveals mere glimpses around the edges of potential concerns. It offers little insight into family strengths, patterns of parenting, specific child needs, cultural barriers, or the lack of resources that can escalate risks for children.
The search for a thorough understanding of a child and family’s circumstances – one that verifies risk and recognizes protective factors – inevitably places an emphasis on extending professional expertise and specialization. For example, we have deepened our awareness of the interplay between mental health, substance abuse, domestic violence, children’s behavioral and medical issues, and the ability to parent. We have gained acumen and skill in treating trauma.
In Massachusetts, parallel to the expansion of professional knowledge about identification and treatment of child abuse and neglect, several reforms have been implemented that address these troubling concerns from a family-centered and community-centered perspective. Because these initiatives are positioned close-up, in the communities where the families are living, they are able to offer a unique contribution to understanding the dilemmas of risk and well-being for children, and new ways to face them. Local partners in these communities can help the formal child welfare system answer these questions:
• Who knows this individual child and family deeply and best?
• Who is aware of family strengths that may not be obvious to an outsider – and is also familiar with the dangers to children that can remain hidden from the formal system?
• Who knows the people families count on to support them on a daily basis?
• Who can identify the risk factors that don’t exist within an individual family, but lie in the social conditions of the community?
Massachusetts Patch is a decade-long change approach that responds to these important questions. In the areas where it operates, Patch is a valued collaborator in the circle of decision-making and accountability for vulnerable children and their families.
What is Patch?
We first wrote about Patch for COMMON GROUND in 2000. To recap from that article, Patch originated in Great Britain where it served as a reform with the aim of bringing public services to neighborhoods where they were needed. Massachusetts Patch planning started in 1997, with the goal of integrating mandated child welfare services with family support in community settings. This advance to a community-linked child welfare practice grew from the recognition that public systems alone cannot generate the local conditions for families to develop the lasting relationships that support them in maintaining long-term safety, permanency and well-being for children. Best family- and community-centered practice involves partnerships not only with families, but also with the web of extended family and community resources that form the family’s personal network of care.
The original Patch pilots were in two geographic areas that demonstrated strong community leadership through their Community Connections Coalitions, but also faced significant challenges in caring for children and families: in the urban Dorchester section of Boston; and the rural North Quabbin region in Northwestern Massachusetts.
In Patch, the formal collaboration between public child welfare workers and local family support organizations is braced by a closely-aligned clinical, managerial and systems structure that is responsive to the challenges inherent in blending state mandates and practices with local cultures, values and practices. Patch involves partnerships at the levels of community practice, local management and statewide administration. It creates an environment for managing the changes in roles and responsibilities that result in best decisions for individual families, the development of community-based solutions to social issues affecting many families, and the successful resolution of families’ issues when barriers exist in the systems designed to help them.
Patch has amassed a remarkable body of knowledge about the value of community inclusion
Progress and results
Since 2000, the Dorchester and North Quabbin Patch sites have continued to fulfill their initial promise. Structures are in place to support functional changes across clinical, management and systemic levels. At the clinical level, a unit of DSS social workers and their supervisor is located at the community Patch site. They join their practice with a Coalition-employed Patch coordinator and family advocate, and a worker from the Department of Youth Services (DYS). At the management level, local DSS, DYS and Coalition administrators meet regularly to manage progress and overcome barriers. Systemically, extended Patch teams that include local mental health, educational and other partners, address the community conditions that affect many local families.
The structures at each level create safe spaces for partners to hold and process together the ambiguity and anxiety inherent in sharing practice, decision-making and resource development for children and families at risk. Because these issues are acknowledged and accommodated organizationally, Patch teams have had a trustworthy platform for launching innovative interventions. These often cross traditional practice boundaries, generating new solutions to age-old problems.
In one case, for example, DSS social workers have created an informal opportunity for family support by sponsoring a monthly brunch for mothers – some of whom continue to participate and offer peer support long after their formal DSS involvement ends. At another site, the Family Team Meeting has become a core practice tool for family engagement, and provides an opportunity for joint practice among DSS workers, community helpers, and families. There is also an active Patch Parents Council that includes families currently or formerly served by DSS. Two parents from this group serve on the Commissioner’s Family Advisory Council.
Another example illustrates the strength of Patch to exercise its influence in addressing a community-level systemic problem and its ability to respond to the interests of many different partners. DSS, the Family Networks lead agency, public school leaders and community representatives collaborated to create a new foster care task force in rural North Quabbin. This group is tackling the problem of local children being placed in geographically distant foster homes. Placement far from home disturbs family and other close relationships, interrupts education, and complicates the ability to access services. It imposes barriers to reunification beyond the original reason for removal, and it reduces the odds of a child maintaining or finding timely permanency; it means more driving for families and for DSS social workers; and it can result in additional expense for strained local school budgets. The goal of the task force is straightforward: To increase the number of local foster homes and to reserve those homes for local children. Successful outcomes will benefit the children, families, DSS, schools and others in the community.
An initial Patch evaluation was conducted in 2002. It involved the creation of a logic model, a data review, and in-depth family interviews. Evaluation findings informed the development of a set of Patch Essential Practices. These practices include: maintaining a local DSS presence; engaging communities in a restorative conversation; and creating formal team structures for families, DSS and other partners to solve problems and be accountable together. In addition to guiding the Patch pilots, these practices have contributed to the design of other DSS initiatives – most notably the design of the Family Networks model – and have provided a template for the development of additional Patch sites.
Next steps for Patch
DSS has recently funded two new Patch sites: in New Bedford; and in Lawrence. The Area Offices are partnering with Community Connections Coalitions to hire and site the teams. Plans are underway to join all four sites in further practice development and evaluation.
In addition to continuing the direct work of Patch, we have started a process to transfer its promising practices into a broader community-connected practice approach for child welfare. Community connected practice describes the work of facilitating relationships between families, supportive community members, providers, and DSS to achieve a mutually defined vision, one that offers concrete, positive results for children and families living in the community.
Currently, DSS is implementing a number of important initiatives, including: Family Networks; the Family Engagement Model; the Commissioner’s Advisory Council on Racial, Ethnic and Linguistic Minority Affairs; Continuous Quality Improvement; Adolescent Permanency; and the Child Welfare Institute. Community connected practice is not an additional reform; it is a campaign to incorporate the lessons learned from Patch exemplifying the DSS core value of community focus into key initiatives. A series of Learning Circles are currently underway that will engage the thinking of DSS and community partners about how to achieve this integration.
From its modest beginnings, Patch has amassed a remarkable body of knowledge about the value of community inclusion, and has gained skill in bringing the community into the circle of identifying, treating and sharing responsibility for children who are at risk and their families. We look forward to the next decade!
